The Nation's Investment in Cancer Research
A Plan and Budget Proposal for Fiscal Year 2008
Prepared by the Director, National Cancer Institute as mandated by The National Cancer Act (P.L. 92-218)
Improving Early Detection and Diagnosis
We will support the development and dissemination of interventions to detect and diagnose early-stage malignancy.
Today's Research
Detecting and diagnosing tumors early in the disease process, before the tumor invades surrounding tissue, can dramatically improve the patient's odds for successful treatment and eliminate a large portion of cancer deaths. Examples in this area include:
- Identifying genes, proteins, or other molecules that signal the presence of cancer based on their patterns or levels of expression (the extent to which they are activated)
- Identifying protein biomarkers for hard-to-detect cancers, such as ovarian and pancreatic cancers, and finding new biomarkersfor prostate cancer
- Using genomic and proteomic profiling to improve prognosis and guide treatment
- Developing anatomical and molecular imaging techniques to detect tumors, improve diagnostic accuracy, and find metastases
- Supporting preclinical evaluation and clinical testing of biomarker and imaging technologies
- Understanding how and why patients accept and comply with cancer screening methods
Tomorrow's Strategies
NCI will help bridge the gaps across the translational spectrum to speed the movement of effective early detection and diagnostic approaches to the clinic. To achieve this, we will:
- Promote collaborative, multidisciplinary research to validate biomarkers of early detection and screening.
- Develop better diagnostic and screening tools for early detection, risk assessment, and disease recurrence.
- Apply evidence-based research findings to intervention development.
- Encourage and provide investigator training to facilitate the development and application of new tests.
- Develop risk factor profiles for identifying patients who are likely to benefit most from cancer screening.
- Determine why abnormal findings from screening examinations have less than acceptable rates of follow-up and develop strategies to improve this part of the health care system.
- Make experimental data accessible across the cancer research community.
- Translate evidence-based research into public health and medical practice.
Moving Research Forward
…with Molecular Profiling of Cancer
Our nation's investment in identifying molecular profiles, or signatures, of cancer has been producing impressive results. As early as 2000, NCI researchers were using gene expression profiling to distinguish between different subtypes of lymphoma. Two years later, investigators were reporting preliminary success using proteomic technologies to detect and diagnose some cancers at early stages. Since then, researchers have been discovering and validating molecular profiling techniques that many experts believe are setting the stage for improved cancer detection and diagnosis.
…and Progress in Pursuit of our Goal
- Defining Ovarian Cancer Subtypes. A new study helped clarify the relationship between low malignant potential (LMP), low-grade, and high-grade serous ovarian tumors. The study suggests that LMP tumors are not early precursors of aggressive ovarian cancer, as had been suspected, but may be part of an entirely different class of tumors. Moreover, the study showed that low-grade serous tumors are more similar to LMP tumors than to high-grade tumors. These findings suggest the need to reexamine treatment options for women with low-grade disease, who currently receive the same therapy as patients with high-grade disease.
- Improved Diagnosis of Burkitt's Lymphoma. A worldwide team of researchers, including some from NCI, showed that gene expression profiling can accurately distinguish between Burkitt's lymphoma and diffuse large B-cell lymphoma (DLBCL). Burkitt's lymphoma and DLBCL cells appear similar when viewed under a microscope, but correct diagnosis is critical because they require very different treatments. If Burkitt's lymphoma patients are treated with intensive therapy, the survival rate is roughly 80 percent. However, if they are misdiagnosed and treated with the lower intensity chemotherapy recommended for DLBCL patients, the survival rate drops to 20 percent or less.
- Sputum Testing for Early Lung Cancer Detection. A prospective clinical trial has found that testing the sputum (coughed up mucus and other matter) of individuals at high risk for lung cancer, by analyzing certain genes and chemicals, may help identify early signs of the disease. The experimental test screens 14 genes associated with lung cancer for the presence of chemicals called methyl groups that can modify genes and silence them (turn them off). The test identified 65 percent of individuals who later developed symptoms of lung cancer, but it also identified 35 percent of cancer-free control participants. Therefore, at this point a patient who tests positive would also need to receive a diagnostic bronchoscopy or x-ray to see if tumors exist.
